Faecal Microbiota Transplants: The evidence and experience
|
|
- Reynold Randall
- 5 years ago
- Views:
Transcription
1 Faecal Microbiota Transplants: The evidence and experience Dr Simon Goldenberg Consultant Microbiologist and Infection Control Doctor Guy s & St Thomas NHS Foundation Trust
2 Gut microbiota and health Level of complexity Course of disease Responders / non-responders Influence of genetics, diet Concomitant medication C. difficile ESBL / VRE / post antibiotic dysbiosis Causality IBD and IBS Insulin resistance / type 2 diabetes / obesity Auoimmune diseases e.g. coeliac Gut-brain axis diseases e.g. autism, MS, chronic fatigue syndrome, parkinsons Adapted from: Aviv Cohen. Dig Dis Sci :5, Bakker Microbiol Spectr :4
3 The burden of CDI recurrence 20% 40% 60% After first episode After first recurrence After two or more recurrences Kelly CP, LaMont JT. N Engl J Med. 2008;359(18): ; Johnson S. International Journal of Antimicrobial Agents 33 (2009) S33-S36. Deshpande et al. ICHE :4, Age 65 years1-4, 10 Severe CDI 1,4 Previous episode of CDI 1,3-5 Co-morbidities including renal failure 1,4,6,7,10 Exposure to concomitant antibiotics4, 10 Infection with particular strains eg RT 027, RT 106 Exposure to PPIs / other gastric acid supressors 8,10 Previous hospital admission 9 1 Kyne et al. Lancet 2001; 357: Bauer et al. Clin Microbiol Infect 2009; 15: Bauer et al. Lancet 2011; 377: Hu et al. Gastro 2009; 136: McFarland et al. Am J Gastroenterol 2002; 97: Do et al. CID 1998; 26: Bauer et al. Clin Microbiol Infect 2011; 17: A1-4 8 Kwok et al. Am J Gastro 2012; 107: Eyre et al. CID 2012; 55: Deshpande et al. ICHE :4,
4 Decreased Diversity of the Faecal Microbiome in Recurrent C. difficile Patients with recurrent C.difficile have decreased phylogenetic richness Chang JY, et al. J Infect Dis 2008:197;435-8 Some bacteria remain disrupted for prolonged periods following antibiotic administration Sadowsky et al. The Fecal Bacteria, 2011 Zaura et al. mbio 6:6 Nov/Dec 2015
5 Faecal Microbiota Transplantation (FMT) Rationale: A perturbed imbalance in intestinal microbiota (dysbiosis) is associated with or causes disease and can be corrected by re-introduction of donor faeces
6 Mechanisms by which the effects of a restored microbiota prevent CDI recurrence Normal microbiota Competitive niche exclusion Direct inhibition of C. difficile growth and its toxigenic activity Modulation of metabolites bile acid transformation Trigger of immune mediated responses
7 Early History of FMT 4th century: Ge Hong described use of human faecal suspension by mouth for diarrhoea and food poisoning Zghou Hou Bei Ji Fang Handy Therapy for Emergencies 16th century: Li Shizhen prescribed fermented faeces for abdominal diseases with diarrhoea, abdominal pain, fever, vomiting and constipation; yellow dragon soup Ben Cao Gang Mu Compendium of Materia Medica
8 17 th century: veterinary medicine: Early History of FMT Transfaunation (transfer of cecal contents or fresh faeces) from healthy horses to treat horses with chronic diarrhoea Rumen transfaunation is used to refaunate cows that have been off-feed because of illness e.g mastitis Modern history: (1958) Eismann et al. 4 patients with fulminant pseudomembranous colitis treated with FMT enema
9 van Nood et al, NEJM, 2013 Study and patient characteristics Outcomes Adverse events Intervention = FMT (nasoduodenal) + vanc + bowel lavage N = 16, F:M = 8 Age(mean/median) = 73 +/- 13 Comparator = vanc N = 13, F:M = 7 Age(mean/median) = 66 +/-14 Comparator = vanc + bowel lavage N = 13, F:M = 3 Age(mean/median) = 69+/-16 Pre-FMT antibiotics = At least one course of adequate antibiotic therapy (>=10 days of Vanc >=125mg qds or >=10 days of Metronidazole 500mg tds). Total follow up period = After first infusion at 10 weeks; follow up was extended to 10 weeks after 2nd infusion Risk of bias assessment = LOW Treatment arm = FMT + vanc + bowel lavage Overall cure rate = 15/16(94%)* Cure with 1 infusion alone = 13/16 (81%)* Treatment arm = vanc Overall cure rate = 4/13 (31%)* patients at 10 weeks Treatment arm = vanc + bowel lavage Overall cure rate = 3/13 (23%)* patients at 10 weeks *P<0.01 Minor GI adverse events = 94% immediate diarrhoea, 31% abdominal pain with cramping, 19% belching - resolved within 3 hours. During follow up 3 patients had constipation (19%). Minor non-gi adverse events = Serious adverse events = Nil described Deaths = None.
10 Cammarota et al, Alimentary Pharmacol & Therap, 2015 Study and patient characteristics Outcomes Adverse events Intervention = FMT (colonoscopy) N = 20, F:M = 12:8 Age(mean/median) = 71 (range 29-89) Comparator = Vancomycin N = 19, F:M = 11:8 Age(mean/median) = 75 (range 49-93) Pre-FMT antibiotics = Vanc taper 19+/- 1 metronidazole Total follow up period = 10 weeks Risk of bias assessment = UNCERTAIN risk of bias Treatment arm = FMT Overall cure rate = 18/20 (90%)* Cure with 1 infusion alone = 13/20 (65%) Treatment arm = Vancomycin Overall cure rate = 5/19 (26%) Minor GI adverse events = 19 diarrhoea, 12 bloating (all resolved at 12 hrs) Minor non-gi adverse events = Serious adverse events = none Deaths = 2- from C.diff related complications.
11 Hota et al, Clinical Infectious Diseases, 2016 Study and patient characteristics Outcomes Adverse events Intervention = FMT (enema) N = 16, F:M = 11 Age(mean/median) = Mean 75.7 Comparator = 6 week vanc taper N = 12, F:M = 8 Age(mean/median) = Mean 69.6 Pre-FMT antibiotics = At least 1 course of vancomycin for min 10 days Total follow up period = 120 days Risk of bias assessment = UNCERTAIN risk of bias Treatment arm = FMT Overall cure rate = 7/16 (44%) Treatment arm = 6 week vanc taper Overall cure rate = 7/12 (58%) P=ns, discontinued following futility analysis Minor GI adverse events = abdominal pain, tenderness and bloating, equal in both groups Minor non-gi adverse events = Serious adverse events = 1 developed anasarca from liver disease, 1 had perf bowel from diverticulitis 35 days post FMT Deaths = None.
12 Lee et al, JAMA, 2016 Study and patient characteristics Outcomes Adverse events Intervention = Frozen FMT (enema) N = 108, F:M = 72 Age(mean/median) = Mean age 73 years Comparator = Fresh FMT (enema) N = 111, F:M = 74 Age(mean/median) = Mean age 73 years Pre-FMT antibiotics = Metronidazole and Vancomycin Total follow up period = 13 weeks Risk of bias assessment = LOW risk of bias Treatment arm = Frozen Overall cure rate = 98/109 (90.7%) Cure with 1 infusion alone = 57/108 (52.8%) Treatment arm = Fresh Overall cure rate = 95/111 (85.6%) Cure with 1 infusion alone = 56/111 (50.5%) Minor GI adverse events = Transient diarrhoea (70%), abdominal cramps (10%), nausea (5%) in 24 hours post FMT; constipation (20%) and flatulence (25%) in follow up period. No difference between the two groups Minor non-gi adverse events = Serious adverse events = 12 patients required hospitalization unrelated to FMT Deaths = 6 deaths in frozen and 13 deaths in fresh arm (unrelated to FMT).
13 Jiang et al, Alimentary Pharmacol & Therap, 2017 Study and patient characteristics Outcomes Adverse events Intervention = Fresh (colonoscopy) N = 25, F:M = 21 Age(mean/median) = Mean 75 (19-97) Comparator = Lyophilised (colonoscopy) N = 23, F:M = 13 Age(mean/median) = 63 (20-87) Comparator = Frozen (colonoscopy) N = 24, F:M = 18 Age(mean/median) = 62.5 (33-88) Pre-FMT antibiotics = Not stated Total follow up period = 2 months Risk of bias assessment = HIGH risk of bias Treatment arm = Fresh Overall cure rate = 25/25 (100%) Treatment arm = Frozen Overall cure rate = 20/24 (83%) Treatment arm = Lyophilised Overall cure rate = 18/23 (78%) Fresh vs. lyophilised P=0.022 Minor GI adverse events = no differences in the three groups. mild transient abdo pain and diarrhoea in 86% of patients. 6 experiences fatigue and 4 had a headache. 2 gained weight Minor non-gi adverse events = Serious adverse events = none Deaths = none.
14 Kao et al, Canadian J Gastroenterol & Hepatol (abstract), 2016 Study and patient characteristics Outcomes Adverse events Intervention = Overall N = 43, F:M = 30 Age(mean/median) = Not stated Comparator = Colonoscopy N = 21, F:M = 13 Age(mean/median) = Mean 67.8 Comparator = Capsule N = 22, F:M = 17 Age(mean/median) = Mean 66.3 Pre-FMT antibiotics = not reported Total follow up period = Not reported Risk of bias assessment = UNCERTAIN risk of bias Treatment arm = Overall Overall cure rate = 41/43 (95%) Treatment arm = Colonoscopy Overall cure rate = 20/22 (91%) Treatment arm = Capsule Overall cure rate = 21/21 (100%) Minor GI adverse events = Transient nausea and vomiting in 2 overall Minor non-gi adverse events = Serious adverse events = Nil Deaths = Nil.
15 Kelly et al, Annals of Internal Medicine, 2016 Study and patient characteristics Outcomes Adverse events Intervention = Donor FMT (colonoscopy) N = 22, F:M = 18 Age(mean/median) = Mean age 48 (SD 16) Comparator = Autologous FMT (colonoscopy) N = 24, F:M = 19 Age(mean/median) = Mean age 55 (SD 14) Total follow up period = 8 week outcome follow up, 6 month safety follow up Risk of bias assessment = LOW risk of bias Treatment arm = Donor FMT Overall cure rate = 20 / 22 (90.9%) Treatment arm = Autologous FMT Overall cure rate = 15/24 (62.5%) P=0.042 Minor GI adverse events = Rates of other solicited AEs (fever, abdominal pain, bloating, nausea, vomiting, diarrhea, flatulence, anorexia, and constipation) did not differ significantly between groups. Minor non-gi adverse events = Serious adverse events = None described Deaths = None.
16 Youngster et al, Clinical infectious diseases, 2014 Study and patient characteristics Outcomes Adverse events Intervention = Colonoscopy N = 10, F:M = 6 Age(mean/median) = Mean 50.4 Intervention = NG N = 10, F:M = 5 Age(mean/median) = Mean 58.6 Pre-FMT antibiotics: treatment failures of a 6- to 8-week taper with Vancomycin (95% of patients) with or without an alternative antibiotic, including Fidaxomicin (70% of participants). Total follow up period = 8 weeks follow up for primary response Risk of bias assessment = UNCERTAIN risk of bias Treatment arm = Overall Overall cure rate = 18/20 (90%) Cure with 1 infusion alone = 14/20 (70%) Treatment arm = Colonoscopy Overall cure rate = 10/10 (100%) Cure with 1 infusion alone = 8/10 (80%) Treatment arm = NG Overall cure rate = 8/10 (80%) Cure with 1 infusion alone = 6/10 (60%) P=ns Minor GI adverse events = Mild abdominal discomfort and bloating in 4 patients (20%). One child treated colonoscopically had a transient fever of 38.8 C on day 2 that resolved spontaneously Minor non-gi adverse events = Serious adverse events = 1 new diagnosis of malignancy, 1 hospitalisation for Fournier gangrene Deaths = 2 deaths (unrelated).
17 Allegretti et al, Gastroenterology (DDW abstract), 2016 Study and patient characteristics Outcomes Adverse events Intervention = Low dose FMT capsules (x30 once) N = 10, F:M = ns Age(mean/median) = ns Comparator = High dose FMT capsules (x30 daily on two consecutive days) N = 9, F:M = ns Age(mean/median) = ns Pre-FMT antibiotics = ns Total follow up period = 8 weeks Risk of bias assessment = UNCERTAIN risk of bias Treatment arm = Low dose FMT capsules (30 pills once) Overall cure rate = 7/10 (70%) Treatment arm = High dose FMT capsules ( 30 pills daily on two consecutive days) Overall cure rate = 7/9 (78%) Minor GI adverse events = none Minor non-gi adverse events = Serious adverse events = none Deaths = none.
18 Systematic review with meta-analysis: the efficacy of FMT for the treatment of recurrent and refractory CDI Single infusion Multiple infusions Author ES (95% CI) % Weight Author ES (95% CI) % Weight Case Series Aas 2003 [33] Agrawal 2016 [44] Allegretti 2014 [42] Brandt 2012 [68] Costello 2015 [69] Dutta 2014 [43] Emmanuelson 2014 [70] Ganc 2015 [34] Garborg 2010 [35] Hamilton 2012 [60] Kassam 2012 [61] Kelly 2012 [36] Kelly 2014 [30] Khan 2014 [62] Kronman 2015 [45] Lee 2014 [63] MacConnachie 2009 [64] Mattila 2012 [47] Patel 2013 [46] Pathak 2014 [65] Ray 2014 [37] Rohlke 2010 [38] Rubin 2013 [39] Satokari 2015 [40] Tauxe 2016 [66] Vigvari 2014 [72] Yoon 2010 [41] Zainah 2015 [67] Subtotal (I^2 = 76.41%, P=.00) 0.94 (0.70, 1.00) 0.83 (0.76, 0.89) 0.86 (0.65, 0.97) 0.88 (0.79, 0.95) 0.85 (0.62, 0.97) 1.00 (0.87, 1.00) 0.65 (0.43, 0.84) 0.83 (0.52, 0.98) 0.73 (0.56, 0.85) 0.86 (0.72, 0.95) 0.81 (0.62, 0.94) 0.92 (0.75, 0.99) 0.77 (0.67, 0.86) 0.90 (0.68, 0.99) 0.90 (0.55, 1.00) 0.48 (0.37, 0.58) 0.73 (0.45, 0.92) 0.90 (0.80, 0.96) 0.87 (0.69, 0.96) 0.92 (0.62, 1.00) 1.00 (0.83, 1.00) 0.95 (0.75, 1.00) 0.79 (0.68, 0.87) 0.96 (0.86, 1.00) 0.77 (0.59, 0.90) 0.90 (0.73, 0.98) 1.00 (0.74, 1.00) 0.57 (0.29, 0.82) 0.86 (0.80, 0.90) Case Series Aas 2003 [33] Agrawal 2016 [44] Allegretti 2014 [42] Brandt 2012 [68] Costello 2015 [69] Dutta 2014 [43] Emmanuelson 2014 [70] Fischer 2016 [59] Ganc 2015 [34] Garborg 2010 [35] Hamilton 2012 [60] Kassam 2012 [61] Kelly 2012 [36] Kelly 2014 [30] Khan 2014 [62] Kronman 2015 [45] Lee 2014 [63] MacConnachie 2009 [64] Mattila 2012 [47] Patel 2013 [46] Pathak 2014 [65] Ray 2014 [37] Rohlke 2010 [38] Rubin 2013 [39] Satokari 2015 [40] Tauxe 2016 [66] Vigvari 2014 [72] Yoon 2010 [41] Youngster 2014 [28] Zainah 2015 [67] Subtotal (I^2=64.82%, P=.00) 0.94 (0.70, 1.00) (0.76, 0.89) (0.65, 0.97) (0.82, 0.96) 1.00 (0.83, 1.00) (0.87, 1.00) (0.47, 0.87) (0.77, 0.85) 0.83 (0.52, 0.98) (0.67, 0.93) (0.84, 0.99) (0.76, 0.99) 0.92 (0.75, 0.99) (0.76, 0.92) (0.83, 1.00) (0.69, 1.00) (0.78, 0.92) (0.52, 0.96) (0.86, 0.98) (0.83, 1.00) (0.74, 1.00) 1.00 (0.83, 1.00) 1.00 (0.83, 1.00) 0.79 (0.68, 0.87) (0.86, 1.00) (0.70, 0.96) (0.83, 1.00) (0.74, 1.00) (0.68, 0.99) (0.49, 0.95) (0.89, 0.95) Quraishi et al, Aliment Pharmacol Ther 2017
19 Safety and efficacy of fecal microbiota transplantation for recurrent C. difficile infection from an international public stool bank: Results from a 2,050 patient multi-center cohort IDWeek healthcare facilities across 50 US states and 7 countries Clinical cure rate across all delivery modalities and CDI patient populations was 84.0% FMT by colonoscopy (85.8% clinical cure, n=1441) was superior to upper endoscopy (74.1% clinical cure, n=201) (p<0.01). 42 AEs were reported; however, no AEs were determined to be definitely related to FMT, 3 were possibly related to FMT and 39 not related
20 Treatment of 3 CDI recurrences If there is a third recurrence after a pulsed vancomycin regimen, FMT should be considered (Conditional recommendation, moderate quality evidence) Am J Gastroenterol Apr;108(4):478-98; For multiple recurrent CDI unresponsive to repeated antibiotic treatment, faecal transplantation in combination with oral antibiotic treatment is strongly recommended (A-I). Clin Microbiol Infect 2014; 20 (Suppl. 2): 1 26
21 Consider donor stool transplant in cases of recurrent CDI This procedure should only be considered for patients with recurrent C. difficile infections that have failed to respond to antibiotics and other treatments.
22 Survey of practice of FMT for CDI in the UK, 2015 N=255: 120 Microbiology / ID 84 Gastroenterology Responding sites England Scotland Wales Total sites responding Sites that performed FMT FMT >1 year FMT <1 year FMT >10 patients FMT<10 patients Quereshi et al. National survey of practice of faecal microbiota transplantation for Clostridium difficile infection in the UK. J Hosp Infect 2016
23 Summary n Success rate of ~90% when FMT is used to treat recurrent CDI n FMT is an appropriate salvage therapy for multiply recurrent CDI n Currently 9 RCTs reported in the literature plus many case series with 1000 s of patients n Lower GI administration appears to be more effective, however is more invasive and costly n Frozen FMT is as effective as fresh, capsulised product also appears to be effective and may become standard route of administration n Significant differences in methods and protocols with lack of standardization Joint HIS/BSG guidelines about to go out for consultation
24
C. difficile: When to Do Fecal Microbiota Transplant (FMT)
C. difficile: When to Do Fecal Microbiota Transplant (FMT) Lawrence J. Brandt, MD, MACG Emeritus Chief, Gastroenterology Montefiore Medical Center Professor of Medicine and Surgery Albert Einstein College
More informationAll POOPed out: fecal microbiota transplant in C. difficile
All POOPed out: fecal microbiota transplant in C. difficile SUSAN M. KELLIE, MD, MPH PROFESSOR OF INTERNAL MEDICINE DIVISION OF INFECTIOUS DISEASES UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE HOSPITAL
More informationGut Microbiota Transplant Pro Position. Christina Surawicz, MD, MACG Professor of Medicine University of Washington Seattle WA
Gut Microbiota Transplant Pro Position Christina Surawicz, MD, MACG Professor of Medicine University of Washington Seattle WA My Focus Recurrent Clostridium difficile infection No uniformly successful
More informationWhen To Do Fecal Microbiota Transplant (FMT) For C. difficile
When To Do Fecal Microbiota Transplant (FMT) For C. difficile Lawrence J. Brandt, MD, MACG Emeritus Chief, Gastroenterology Montefiore Medical Center Professor of Medicine and Surgery Albert Einstein College
More informationFecal Microbiota Transplantation (FMT): Current Concepts in Clostridium difficile and beyond
Fecal Microbiota Transplantation (FMT): Current Concepts in Clostridium difficile and beyond Amir Patel, MD Assistant Professor of Medicine Froedtert Hospital and the Medical College of Wisconsin I have
More informationFecal Microbiota Transplantation
Protocol Fecal Microbiota Transplantation (20192) Medical Benefit Effective Date: 10/01/14 Next Review Date: 07/18 Preauthorization Yes Review Dates: 07/14, 07/15, 07/16, 07/17 Preauthorization is required.
More informationCorporate Medical Policy Fecal Microbiota Transplantation
Corporate Medical Policy Fecal Microbiota Transplantation File Name: Origination: Last CAP Review: Next CAP Review: Last Review: Fecal_microbiota_transplantation 7/2014 11/2017 11/2018 11/2017 Description
More informationFecal Microbiota Transplantation. Description
Section: Medicine Effective Date: April 15, 2017 Original Policy Date: September 12, 2014 Subject: Fecal Microbiota Transplantation Page: 1 of 10 Last Review Status/Date: March 2017 Fecal Microbiota Transplantation
More informationOCTOBER 7-10 PHILADELPHIA, PENNSYLVANIA
OMED 17 OCTOBER 7-10 PHILADELPHIA, PENNSYLVANIA 29.5 Category 1-A CME credits anticipated ACOFP / AOA s 122 nd Annual Osteopathic Medical Conference & Exposition Joint Session with ACOFP and Cleveland
More informationFecal Microbiota Transplantation in C. diff. colitis Benefits and Limitations
January 27th 2017, 8th Gastro Foundation Weekend for Fellows; Spier Hotel & Conference Centre, Stellenbosch Fecal Microbiota Transplantation in C. diff. colitis Benefits and Limitations Gerhard Rogler,
More informationFecal microbiota transplantation: The When,the How and the Don t. By Dr Rola Hussein
Fecal microbiota transplantation: The When,the How and the Don t By Dr Rola Hussein Introduction Fecal microbiota transplantation (FMT) involves administration of fecal material containing distal gut microbiota
More informationStar Articles in Review
Star Articles in Review CDDW/CASL Meeting Toronto, February 10, 2014 Christina M. Surawicz, MD MACG Professor of Medicine Division of Gastroenterology Department of Medicine University of Washington Disclosure
More informationClinical Policy Bulletin: Fecal Bacteriotherapy
Clinical Policy Bulletin: Fecal Bacteriotherapy Number: 0844 Policy Aetna considers fecal bacteriotherapy medically necessary for persons with Clostridium difficile infection, with infection confirmed
More informationFECAL TRANSPLANTATION
FECAL TRANSPLANTATION From Theory to Practice in Ridge Meadows Edward Auersperg 13 January 2016 The Human Genome How many different chromosomes do humans have? 46 chromosomes 23 pairs The Human Genome
More informationFecal Microbiota Transplantation
Fecal Microbiota Transplantation Policy Number: 2.01.92 Last Review: 7/2018 Origination: 5/2015 Next Review: 7/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for
More informationTreatment Update on Fecal Microbiota Transplantation. Arnab Ray, MD Ochsner Clinic Foundation Gastroenterology Department
Treatment Update on Fecal Microbiota Transplantation Arnab Ray, MD Ochsner Clinic Foundation Gastroenterology Department Disclosure I serve as a paid medical monitor for Rebiotix Objectives The scope of
More informationStony Brook Adult Clostridium difficile Management Guidelines. Discontinue all unnecessary antibiotics
Stony Brook Adult Clostridium difficile Management Guidelines Summary: Use of the C Diff Infection (CDI) PowerPlan (Adult) Required Patient with clinical findings suggestive of Clostridium difficile infection
More informationClinical Review Criteria Fecal Microbial Transplant for Treatment of C. Difficile Infection Fecal GI Infusion Fecal Capsule (G3 OpenBiome)
Clinical Review Criteria Fecal Microbial Transplant for Treatment of C. Difficile Infection Fecal GI Infusion Fecal Capsule (G3 OpenBiome) Criteria Codes Revision History Kaiser Foundation Health Plan
More informationFecal transplantation as a treatment option for recurrent Clostridium difficile infection
Fecal transplantation as a treatment option for recurrent Clostridium difficile infection Josbert Keller Department of Gastroenterology Haga Teaching Hospital, The Hague Case: 81 yrs, CVA, recurrent UTI,
More informationManaging Clostridium Difficile: An Old Bug With
932 The Red Section see related editorial on page x Managing Clostridium Difficile: An Old Bug With New Tricks Stephen M. Vindigni, MD, MPH 1,2 and Christina M. Surawicz, MD 1 Am J Gastroenterol (2018)
More informationDivision of GIM Lecture Series Case Presentation David A. Erickson, M.D October 9th, 2013
Division of GIM Lecture Series Case Presentation David A. Erickson, M.D October 9th, 2013 Financial Disclosures No financial disclosures Objectives Review a case of recurrent Clostridium difficile infection
More information(No Image Selected) Video Submission Confirmation: No Video Upload: Abstract Author: Investigator Commercial Products or Services: No Designed Study:
Found 3 Abstracts CONTROL ID: 1745628 TITLE: Fecal Microbiota Transplantation (FMT) for Treatment of Clostridium difficile Infection (CDI) in Immunocompromised Patients CONTACT (NAME ONLY): Colleen Kelly
More informationTitle: Fecal microbiota transplantation in recurrent Clostridium difficile infection in a patient with concomitant inflammatory bowel disease
Title: Fecal microbiota transplantation in recurrent Clostridium difficile infection in a patient with concomitant inflammatory bowel disease Authors: Marta Gravito-Soares, Elisa Gravito-Soares, Francisco
More informationFecal microbiota transplantation: Breaking the chain of recurrent C. difficile infection
Fecal microbiota transplantation: Breaking the chain of recurrent C. difficile infection Issue Date: June 2013 Vol. 8 No. 6 Author: Amy Marinski, MSN, RN, CCRN, CNL More than 3 million new cases of Clostridium
More informationENGLISH FOR PROFESSIONAL PURPOSES UNIT 3 HOW TO DEAL WITH CLOSTRIDIUM DIFFICILE
ENGLISH FOR PROFESSIONAL PURPOSES UNIT 3 HOW TO DEAL WITH CLOSTRIDIUM DIFFICILE The diagnosis of CDI should be based on a combination of clinical and laboratory findings. A case definition for the usual
More informationPatient presentation
Update: Clostridium difficile Colitis David H. Kerman, MD Assistant Professor of Clinical Medicine Director, Fellowship Program Division of Gastroenterology University of Miami Miller School of Medicine
More informationACP Aaron Fieker, D.O
ACP 2016 Aaron Fieker, D.O Colorectal cancer (CRC) Update on screening strategies and tools Irritable Bowel Syndrome (IBS) New therapeutic options C-difficile Updates on treating recurrent disease CRC
More informationMEDICAL POLICY SUBJECT: FECAL BACTERIOTHERAPY EFFECTIVE DATE: 08/16/12 REVISED DATE: 08/15/13, 07/17/14, 07/16/15, 06/16/16, 06/15/17
MEDICAL POLICY SUBJECT: FECAL BACTERIOTHERAPY PAGE: 1 OF: 7 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including
More informationCase 1. Which of the following would be next appropriate investigation/s regarding the pts diarrhoea?
Case 1 21 yr old HIV +ve, Cd4-100 HAART naïve Profuse diarrhoea for 3/52. Stool MC&S ve Which of the following would be next appropriate investigation/s regarding the pts diarrhoea? Repeat stool MC&S Stool
More informationClinical Infectious Diseases Advance Access published December 7, 2012
Clinical Infectious Diseases Advance Access published December 7, 2012 1 Physician Attitudes Towards the Use of Fecal Transplantation for Recurrent Clostridium Difficile Infection in a Large Metropolitan
More informationMicrobiome GI Disorders
Microbiome GI Disorders Prof. Ram Dickman Neurogastroenterology Unit Rabin Medical Center Israel 1 Key Points Our gut microbiota Were to find them? Symbiosis or Why do we need them? Dysbiosis or when things
More informationNicola Petrosillo Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS Roma. L infezione da C difficile grave o complicata
Nicola Petrosillo Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS Roma L infezione da C difficile grave o complicata Bagdasarian N et al. JAMA 2015; 313: 398-408 European Society
More informationWhat s New for Clostridium difficile John Lynch MD MPH Harborview Medical Center University of Washington
What s New for Clostridium difficile 2013 John Lynch MD MPH Harborview Medical Center University of Washington Pathogenic Mechanisms of Diarrhea Toxins: Preformed: S aureus, C perfringens, B cereus Formed
More informationBENEFIT APPLICATION BLUE CARD/NATIONAL ACCOUNT ISSUES
Medical Policy BCBSA Ref. Policy: 2.01.92 Last Review: 11/15/2018 Effective Date: 11/15/2018 Section: Medicine Related Policies 2.04.26 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis DISCLAIMER
More informationClostridium difficile Infection (CDI) Management Guideline
Clostridium difficile Infection (CDI) Management Guideline Do not test all patients with loose or watery stools for CDI o CDI is responsible for
More informationAccepted Article. Fecal microbiota transplantation - something more than merely a therapeutic curiosity
Accepted Article Fecal microbiota transplantation - something more than merely a therapeutic curiosity CARLOS FERRE ARACIL, Lara Aguilera Castro, Enrique Rodriguez de Santiago, Ana García García de Paredes,
More informationInitial Experience of Faecal Microbiota Transplantation for the Treatment of Clostridium difficile Infection in Hong Kong
HA Convention 2018 Initial Experience of Faecal Microbiota Transplantation for the Treatment of Clostridium difficile Infection in Hong Kong Rashid NS Lui MBChB (CUHK), MRCP (UK), FHKCP Division of Gastroenterology
More informationUpdates to pharmacological management in the prevention of recurrent Clostridium difficile
Updates to pharmacological management in the prevention of recurrent Clostridium difficile Julia Shlensky, PharmD PGY2 Internal Medicine Resident September 12, 2017 2017 MFMER slide-1 Clinical Impact Increasing
More information9/18/2018. Clostridium Difficile: Updates on Diagnosis and Treatment. Clostridium difficile Infection (CDI) Clostridium difficile Infection (CDI)
Clostridium Difficile: Updates on Diagnosis and Treatment Elizabeth Hudson, DO, MPH 9/25/18 Antibiotic-associated diarrhea and colitis were well established soon after widespread use of antibiotics In
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationModern approach to Clostridium Difficile Infection
Modern approach to Clostridium Difficile Infection Pseudomembranous Colitis: Principles for diagnosis and treatment Aggelos Stefos Internist, Infectious diseases Specialist Department of Medicine and Research
More informationLong-Term Care Updates
Long-Term Care Updates April 2018 By Austin Smith, PharmD Candidate and Lindsay Slowiczek, PharmD is the most common healthcare-acquired infection (HAI) in the United States. 1,2 A 2014 prevalence survey
More informationL infezione da Clostridium difficile (CDI) Quadri clinici e nuovi approcci terapeutici
L infezione da Clostridium difficile (CDI) Quadri clinici e nuovi approcci terapeutici Roberto Luzzati SC Malattie Infettive, AOU Trieste Presidente :Prof. Enzo Raise Clinical presentation of infection
More informationLe infezioni da Clostridium difficile, gravi, ricorrenti e complicate Nicola Petrosillo
Le infezioni da Clostridium difficile, gravi, ricorrenti e complicate Nicola Petrosillo Istituto Nazionale per le Malattie Infettive «lazzaro Spallanzani», IRCCS-Roma The infectious cycle of transmission
More informationDuodenal infusion of donor feces for recurrent Clostridium difficile infection A French experience
Duodenal infusion of donor feces for recurrent Clostridium difficile infection A French experience Benoit Guery Unité des Maladies Infectieuses CHRU - Faculté de Médecine Lille Conflicts of interest Conferences,
More informationUpdates in Fecal Microbial Transplant
Updates in Fecal Microbial Transplant Dina Kao, MD FRCPC Associate Professor, Gastroenterology University of Alberta Nikhil Pai, MD FAAP FRCPC Assistant Professor, Ped Gastroenterology McMaster University
More informationClostridium difficile Infection: Diagnosis and Management
Clostridium difficile Infection: Diagnosis and Management Brian Viviano D.O. Case study 42 year old female with history of essential hypertension and COPD presents to ED complaining of 24 hours of intractable,
More informationClostridium Difficile Infection: Applying New Treatment Guidelines and Strategies to Reduce Recurrence Rate
Clostridium Difficile Infection: Applying New Treatment Guidelines and Strategies to Reduce Recurrence Rate Objectives Summarize the changing epidemiology and demographics of patients at risk for Clostridium
More informationLiterature Scan: Antibiotics for Clostridium difficile Infection. Month/Year of Review: May 2015 Date of Last Review: April 2012
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationPennington Feb 19, 2015
Trust your gut Pennington Feb 19, 2015 Crohn s Disease -an autoimmune disorder that causes inflammation of the intestinal tract along with unpredictable, often incapacitating episodes of abdominal pain
More informationCLINICAL MEDICAL POLICY
Policy Name: Policy Number: Responsible Department(s): CLINICAL MEDICAL POLICY Fecal Microbiota Transplant MP-066-MD-PA Medical Management Provider Notice Date: 10/15/2018; 01/15/2018 Issue Date: 11/15/2018;
More informationDepartment of Surgery, Indiana University School of Medicine, Indianapolis, IN,
1 Fecal Microbiota Transplantation plus selected use of antibiotics for severe-complicated Clostridium difficile infection: description of a protocol with high success rate Monika Fischer MD MSc 1, Brian
More informationTreating and Preventing. C. difficile Infections A Review of the Research for Adults
Treating and Preventing C. difficile Infections A Review of the Research for Adults e Is This Information Right for Me? This information is right for you if: Your health care professional has said that
More informationOngoing Developments in Management of Clostridium difficile Infection
Ongoing Developments in Management of Clostridium difficile Infection Infectious Diseases Spring Symposium Creighton University School of Medicine April 28, 2018, Omaha, NB Stuart Johnson, MD Loyola U.
More informationThe Potential For Microbiome Modification In Critical Illness. Deborah Cook
The Potential For Microbiome Modification In Critical Illness Deborah Cook To review Objectives The microbiome & concepts about its modification during critical illness Interventions Predisposition to
More informationUpdate on Clostridium difficile infection.
Update on Clostridium difficile infection. K. Honein Gastroenterologist, HDF Associate Professor Head of Medicine Department St Joseph University-Beirut. Introduction Gram+anaerobic bacillus responsible
More informationClinical Policy Title: Fecal transplantation for clostridium difficile infection
Clinical Policy Title: Fecal transplantation for clostridium difficile infection Clinical policy number: 08.02.02 Effective Date: October 1, 2014 Initial Review Date: June 18, 2014 Most Recent Review Date:
More informationUpdated Clostridium difficile Treatment Guidelines
Updated Clostridium difficile Treatment Guidelines Arielle Arnold, PharmD, BCPS Clinical Pharmacist Saint Alphonsus Regional Medical Center September 29 th, 2018 Disclosures Nothing to disclose Learning
More informationClostridium difficile CRISTINA BAKER, MD, MPH INFECTIOUS DISEASE PARK NICOLLET/HEALTH PARTNERS 11/9/2018
Clostridium difficile CRISTINA BAKER, MD, MPH INFECTIOUS DISEASE PARK NICOLLET/HEALTH PARTNERS 11/9/2018 Disclosures None Objectives Highlight important changes in the management of Clostridium difficile
More informationCLINICAL MEDICAL POLICY
Policy Name: Policy Number: Responsible Department(s): CLINICAL MEDICAL POLICY Fecal Microbiota Transplant MP-066-MD-DE Medical Management Provider Notice Date: 10/15/2018; 04/15/2018 Issue Date: 11/15/2018;
More informationFIS 2013, Birmingham
Fidaxomicin: CDDFT Case Studies Dr Deepa Nayar County Durham and Darlington Foundation Trust FIS 2013, Birmingham This meeting has been initiated and funded by Astellas Pharma Ltd. County Durham and Darlington
More informationResponders as percent of overall members in each category: Region: New England 50 (57% of 87 members) 46 (57% of 81 members) 21 (55% of 38 members)
Infectious Diseases Society of America Emerging Infections Network Report for Query: Recurrent C. difficile Infections (CDI) Overall response rate: 621/1212 (51.2%) physicians responded from 09/26/12 to
More informationCLOSTRIDIUM DIFICILE. Negin N Blattman Infectious Diseases Phoenix VA Healthcare System
CLOSTRIDIUM DIFICILE Negin N Blattman Infectious Diseases Phoenix VA Healthcare System ANTIBIOTIC ASSOCIATED DIARRHEA 1978: C diff first identified 1989-1992: Four large outbreaks in the US caused by J
More informationAntibiotic Associated Diarrhea (AAD) and Clostridium Difficile Infection (CDI)
Antibiotic Associated Diarrhea (AAD) and Clostridium Difficile Infection (CDI) Dario Conte, M.D. Gastroenterology and Endoscopy Unit Postgraduate School of Gastroenterology Fondazione IRCCS Ca Granda Ospedale
More informationInternational Journal of Food and Allied Sciences
International Journal of Food and Allied Sciences ISSN: 2415-0290 (Print) ISSN: 2413-2543 (Online) DOI:10.21620/ijfaas.2017120-26 Research Article History The Role of Saccharomyces boulardii in the Treatment
More informationFecal Microbiota Transplantation: Clinical and experimental studies van Nood, E.
UvA-DARE (Digital Academic Repository) Fecal Microbiota Transplantation: Clinical and experimental studies van Nood, E. Link to publication Citation for published version (APA): van Nood, E. (2015). Fecal
More informationAtypical Presentation of Clostridium Difficille Infection (CDI).
Article ID: WMC004648 ISSN 2046-1690 Atypical Presentation of Clostridium Difficille Infection (CDI). Peer review status: No Corresponding Author: Dr. Syed A Gardezi, CT1, Medicine,NevillHall Hospital
More informationABSTRACT PURPOSE METHODS
ABSTRACT PURPOSE The purpose of this study was to characterize the CDI population at this institution according to known risk factors and to examine the effect of appropriate evidence-based treatment selection
More informationThe Epidemiology of Clostridium difficile DANIEL SAMAN, DRPH, MPH RESEARCH SCIENTIST ESSENTIA INSTITUTE OF RURAL HEALTH
The Epidemiology of Clostridium difficile DANIEL SAMAN, DRPH, MPH RESEARCH SCIENTIST ESSENTIA INSTITUTE OF RURAL HEALTH Some history first Clostridium difficile, a spore-forming gram-positive (i.e., thick
More informationmore intense treatments are needed to get rid of the infection.
What Is Clostridium Difficile (C. Diff)? Clostridium difficile, or C. diff for short, is an infection from a bacterium that can grow in your intestines and cause bad GI symptoms. The main risk of getting
More informationDISCLOSURE Relevant relationships with commercial entities Wyeth (received advisory board & speaker honoraria) Potential for conflicts of interest wit
GASTROENTERITIS DISCLOSURE Relevant relationships with commercial entities Wyeth (received advisory board & speaker honoraria) Potential for conflicts of interest within this presentation fidaxomicin (which
More informationCLOSTRIDIUM DIFFICILE: IMPROVING DIAGNOSIS AND TREATMENT. Joshua T. Watson, M.D. Lowcountry Gastroenterology Associates
CLOSTRIDIUM DIFFICILE: IMPROVING DIAGNOSIS AND TREATMENT Joshua T. Watson, M.D. Lowcountry Gastroenterology Associates Learning Objectives Recognize patients who are highest risk for C. diff infections
More informationPrevention of Cdiff recurrence: Evidence from a Cdiff Antitoxin
Prevention of Cdiff recurrence: Evidence from a Cdiff Antitoxin Prof. Emilio Bouza Departament of Medicine. Hospital Gregorio Marañon and Complutense University. Madrid. Spain Disclosures Last year Participation
More informationClinical Primer: Position Statement for Fecal Microbiota Transplantation Administration for Recurrent Clostridium difficile Infection
Clinical Primer: Position Statement for Fecal Microbiota Transplantation Administration for Recurrent Clostridium difficile Infection Zain Kassam MD, MPH, FRCPC Chief Medical Officer, OpenBiome Disclaimer
More informationSubject: Fecal Microbiota Transplantation
02-40000-24 Original Effective Date: 09/15/14 Reviewed: 07/26/18 Revised: 08/15/18 Subject: Fecal Microbiota Transplantation THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION
More informationPatient Safety Summit 2014
Patient Safety Summit 2014 The War on C Diff Mark Mellow, MD + C Diff The Organism Gram + bacillus Anaerobic Spore forming Intestinal flora (up to 35% hospitalized patients, 3% of healthy adults) Leading
More informationUpdate on C. difficile: Diagnosis and Therapy Including Fecal Transplant
Update on C. difficile: Diagnosis and Therapy Including Fecal Transplant Colleen R. Kelly, MD Clinical Assistant Professor of Medicine Brown University Warren Alpert School of Medicine Rhode Island Chapter,
More informationThe GI Microbiome and its role in Chronic Fatigue Syndrome: a Summary of Bacteriotherapy
The GI Microbiome and its role in Chronic Fatigue Syndrome: a Summary of Bacteriotherapy Thomas J. Borody, MD, PhD 1 ; Anna Nowak, BMedSci 2 ; Sarah Finlayson, BSc (Adv) Hons 3 1. Thomas J. Borody, MD,
More informationClostridium difficile Infection (CDI)
18.09.10 월요집담회 Clostridium difficile Infection (CDI) R4 송주혜 Clostridium difficile infection (CDI) Anaerobic gram (+), spore-forming, toxin(tcda&tcdb)-producing bacillus Transmitted among humans through
More informationClostridium difficile
Clostridium difficile Sarah Doernberg, MD, MAS Assistant Professor, University of California, San Francisco Medical Director, Adult Antimicrobial Stewardship Disclosures: Consultant for Actelion, prior
More informationEDUCATIONAL COMMENTARY CLOSTRIDIUM DIFFICILE UPDATE
EDUCATIONAL COMMENTARY CLOSTRIDIUM DIFFICILE UPDATE Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits click
More informationClostridium difficile (C difficile)
Patient Knowledge and Attitudes About for Clostridium difficile Infection Colin Goodman, MD; Nicholas O Rourke, PharmD; Carla Amundson, MA; and Dimitri Drekonja, MD, MS In a survey of patients with Clostridium
More informationClostridium difficile: Can you smell the new updates?
Clostridium difficile: Can you smell the new updates? Sunish Shah, Pharm.D. PGY-2 Infectious Disease Pharmacy Resident Yale-New Haven Hospital sshah1741@mail.usciences.edu Learning objectives Recognize
More informationPredictors of Early Failure After Fecal Microbiota Transplantation for the Therapy of Clostridium Difficile Infection: A Multicenter Study
nature publishing group ORIGINAL CONTRIBUTIONS 1 see related editorial on page x Predictors of Early Failure After Fecal Microbiota Transplantation for the Therapy of Clostridium Difficile Infection: A
More informationAnnex C: - CDI What s the diff? 4 th Annual Outbreak Management Workshop September 19, 2013 Naideen Bailey & Grace Volkening
Annex C: - CDI What s the diff? 4 th Annual Outbreak Management Workshop September 19, 2013 Naideen Bailey & Grace Volkening There s an updated Annex C Annex C is an extension to the PIDAC Infection Prevention
More informationClostridium difficile infections and fecal transplant
Objectives Clostridium difficile infections and fecal transplant Recognize patients at risk for C. difficile infection (CDI) Contrast diagnostic testing for CDI Describe treatment strategies for mild,
More informationManagement of the Hospitalized IBD Patient. Drew DuPont MD
Management of the Hospitalized IBD Patient Drew DuPont MD Ulcerative Colitis: Indications for Admission Severe ulcerative colitis Frequent loose bloody stools ( 6 per day) Severe cramps Systemic toxicity:
More informationC. difficile and ASP Guidelines and Best Practices. Belinda Ostrowsky, MD, MPH, FSHEA, FIDSA February 27 and 28, 2018
C. difficile and ASP Guidelines and Best Practices Belinda Ostrowsky, MD, MPH, FSHEA, FIDSA February 27 and 28, 2018 Disclosure I have no financial disclosures I have made a recent transition from Montefiore
More informationJourney to Decreasing Clostridium Difficile and the Unexpected Twist. Jackie Morton, Infection Prevention Cortney Swiggart, Medication Safety Officer
Journey to Decreasing Clostridium Difficile and the Unexpected Twist Jackie Morton, Infection Prevention Cortney Swiggart, Medication Safety Officer 4/13/2018 Objectives Discuss the organism and clinical
More informationDiagnosis, Management, and Prevention of Clostridium difficile infection in Long-Term Care Facilities: A Review
Diagnosis, Management, and Prevention of Clostridium difficile infection in Long-Term Care Facilities: A Review October 18, 2010 James Kahn and Carolyn Kenney, MSIV Overview Burden of disease associated
More informationFecal Microbiota Transplantation: How it s Done, How it Works, and What Challenges Does it Face
The Chinese University of Hong Kong, Faculty of Medicine, Department of Microbiology Joint Graduate Student Seminar Fecal Microbiota Transplantation: How it s Done, How it Works, and What Challenges Does
More informationACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Clostridium difficile Infections
ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Clostridium difficile Infections Christina M. Surawicz, MD 1, Lawrence J. Brandt, MD 2, David G. Binion, MD 3, Ashwin N. Ananthakrishnan,
More information10/4/2014. The Microbiome vs. the Gastroenterologist. Human Microbiome. Microbiome and Host Physiology: A Delicate Balance
The Microbiome vs. the Gastroenterologist John K. Marshall MD MSc FRCPC AGAF Division of Gastroenterology McMaster University Human Microbiome Mouth Finlay BB. Scientific American 2010;302:56-63 Microbiome
More informationAntibiotic treatment comparison in patients with diarrhea
Original Research Article Antibiotic treatment comparison in patients with diarrhea Deva Lal Kast * Senior Consultant Physician, Department of General Medicine, Krishna Hospital, Ex senior Specialist and
More informationMarch 3, To: Hospitals, Long Term Care Facilities, and Local Health Departments
March 3, 2010 To: Hospitals, Long Term Care Facilities, and Local Health Departments From: NYSDOH Bureau of Healthcare Associated Infections HEALTH ADVISORY: GUIDANCE FOR PREVENTION AND CONTROL OF HEALTHCARE
More informationOriginal Article YH FANG, J CHEN, JD YU, YY LUO, JG LOU. Key words. Introduction
HK J Paediatr (new series) 2017;22:199-203 Original Article The Preliminary Investigation of Faecal Microbiota Transplantation for Paediatric Recurrent Chronic Bowel Diseases and Literature Review YH FANG,
More informationBezlotoxumab (Zinplava) as Adjunct Treatment for Clostridium difficile. Janel Liane Cala, RPh Medical Center Hospital
Bezlotoxumab (Zinplava) as Adjunct Treatment for Clostridium difficile Janel Liane Cala, RPh Medical Center Hospital Objectives Review pathophysiology, risk factors, prevention, and treatment options of
More informationClostridium Difficile Infection in Adults Treatment and Prevention
Clostridium Difficile Infection in Adults Treatment and Prevention Definition: Clostridium Difficile colonizes the human intestinal tract after the normal gut flora has been altered by antibiotic therapy
More information